机器人辅助腰椎MIS-TLIF手术的临床应用研究
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清华大学附属北京垂杨柳医院

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An An New MIS-TLIF Technique: Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion
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Bei Jing Chui Yang Liu Hospital

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    摘要:

    摘要 目的:研究骨科手术机器人辅助完成腰椎MIS-TLIF手术的可行性和安全性,初步探讨骨科手术机器人在腰椎微创手术中的应用价值。方法:回顾性分析我院行MIS-TLIF手术治疗的32例单节段退行性腰椎疾病患者临床资料,其中机器人MIS-TLIF组12例,传统MIS-TLIF组20例。比较两组的手术时间、出血量、椎弓根置钉准确率、手术前后视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和并发症情况。术后1个月随访时采用Macnab标准评价临床疗效。结果:32例患者均获得随访,随访时间为术后1个月。与传统MIS-TLIF组相比,机器人MIS-TLIF组手术时间[(168.70±10.12)min比(210.85±35.71)min]较短,差异有统计学意义(p值<0.01);术中出血量[(94±25)ml比(115.50±75.22)ml]较少,但差异无统计学意义(p值>0.05)。机器人MIS-TLIF组的置钉准确性高于传统MIS-TLIF组(χ2=4.313, p值<0.05)。与术前比较,两组患者术后VAS和ODI均显著改善。两组间疗效差异无统计学意义(χ2=0.12, p值>0.05)。结论:机器人辅助下MIS-TLIF治疗单节段退行性腰椎疾病可取得与传统MIS-TLIF相同的临床疗效。骨科手术机器人辅助MIS-TLIF可缩短手术时间、降低并发症及术者疲劳感,具有临床应用价值。

    Abstract:

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique has been demonstrated an effective method in the treatment of lumbar disc diseases. Usually, pedicle screws need to be implanted with X-ray assistance to stabilize the spine after decompression in MIS-TLIF operation. Robot-assisted MIS-TLIF hasn’t been reported yet. Objectives: To find the difference and clinical effects of robot-assisted MIS-TLIF by comparing with X-ray assisted traditional MIS-TLIF in the treatment of degenerative lumbar diseases. Methods: Altogether 32 patients was included this retrospective analysis, among which 12 cases underwent robot-assisted MIS-TLIF (Group Robot), 20 cases with traditional MIS-TLIF operation (Traditional Group). All the cases were carried out by the same surgery team. The operative time, intra-operative blood loss, visual analogue scale (VAS), oswestry disability index (ODI) and complications were recorded and compared between two groups. Further,postoperative computer tomography scans were checked to evaluate the accuracy of the implanted pedicle screws with the Gertzbein-Robbins methods. The clinical outcomes were recorded with the MacNab criteria. Results All cases were followed up at least one month. Compared with traditional group, the Robot-assisted group cost shorter operative time (164.33±10.38min vs. 192.50±17.28min), less intra-operative blood(97.08±23.98 ml vs.127.50±21.00ml). Images of post-operative CT showed that the pedicle screws in the robot-assisted group were more precisely implanted than traditional group (χ2 = 5.485, p < 0.05). VAS score of Both Group had decreased dramatically, with no significant difference between two groups. Accordingly, ODI score had improved in both groups in the one month duration after surgery, also there were no significant difference between the two groups ( χ2=0.16, p >0.05 ). Conclusions Robot-assisted MIS-TLIF own the same efficacy as traditional X-ray assisted operation in the treatment of single level degenerative lumbar diseases. This new technique can decrease the operation time and the intra-operative blood loss, but do not increase the perioperative complications.

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  • 收稿日期:2019-07-25
  • 最后修改日期:2019-08-27
  • 录用日期:2019-09-30
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